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Point of Service Good for measuring the effect of changes tested Focus on meaningful measures Have 4-6 response choices Include 8-20 measures Document collection methodology; train staff collecting information Collect just enough data Have at least 15 completed surveys and 15 measurement points Easy to develop reports Data collection is burdensome! 13

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Telephonic Surveys More rapid feedback than mailed surveys Typically less expensive Outside vendors do it and provide reports Easy to manipulate data for reporting Less frequent – monthly data at best Literature suggests more bias than mailed surveys 14

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Sample Comment Card Comment Card We would like to know what you think about your visit with Doctor X. Yes, Definitely Yes, Somewhat, No Did Dr. X listen carefully to you? Did Dr. X explain things in a way that was easy to understand? Is there anything you would like to comment on further? Thank you. We are committed to improving the care and services we provide our patients. 15

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Patient Exit Interviews Rapid feedback on changes tested Not burdensome to collect data Uncover new issues which may go unreported in surveys Requires translation of information into actionable behaviors Providers see the feedback Include 3-5 questions, mix of specific measures and open ended questions Receptionist or non-clinic member obtains feedback (HP or IPA staff) 16

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20 Start Small, then Scale Up 3 -10 Practices 6 – 8 months 6 – 12 months Learn about getting results at your practices Develop physician and staff champions Understand what it takes from the group to support practice changes Design systems and tools to support changes across many sites Thanks to Chuck Kilo, MD Network Rollout

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Improvement Project AIM: To improve CAHPS scores by achieving the 50 th percentile in the following composites by MY 2012: –Access to care –Provider-patient communication APPROACH –Begin with 10 pilots –Spread to most providers by MY 2011 21

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Purposes for Measurement 1.For Leadership to know if changes have an impact and to build a compelling case to spread changes to other clinics 2.For Clinics to get rapid feedback on tests of change to understand their progress towards their own aims 22

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Patient Ratings of their Care Standardized survey instrument based on the Clinician-Group CAHPS visit survey, about 30 questions Administered at the point of care by clinic –SFHP provides surveys in 3 languages (English, Spanish, Chinese) and picks up surveys on Friday of each week Defined methodology – all patients, given after the visit Five fielding periods: April 2010, July 2010, Oct 2010, Jan 2011, April 2011 Each fielding period is 3 weeks Risk adjusted results at the provider level with roll up at clinic level Extra incentives – up to $500 per clinic 24

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Clinic/Practice Site Satisfaction Survey instrument based on the Dartmouth and Tantau & Associates, about 20 questions Administered online by SFHP –SFHP sends a link to complete the survey online –Anonymous, results can be aggregated by role Five fielding periods: March 2010, June 2010, Sept 2010, Dec 2010, March 2011 Each fielding period is 2 weeks Results at the clinic level 2 weeks following the close of the measurement period 25

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32 Total number of completed responses per question by measurement period Measurement Period Warm greeting Spend enough Time Explains things well Receptionist Helpful Receptionist Respectful 9/22/09-9/24/0923 2223 10/5/09-10/16/0917 1817 11/4/09- 11/16/0941 12/1/09-12/4/09 34 Measurement PeriodPatient Comments 9/22/09-9/24/09 Liked the questionnaire handed to me at my visit. The doctor remembered that I went on a trip - what a great memory! 10/5/09-10/16/09 11/4/09-11/16/09 11/16-11/25/09 12/1/09-12/4/09 Opportunities for Improvement Explains things well Spends enough time Print an after visit summary (see attached) Use "ask before telling" technique and use short summaries technique.